Polycystic ovary syndrome (PCOS) affects up to 12 percent of reproductive Americans with female sex organs. When diagnosing PCOS, doctors look for two or more of the following: high levels of androgens (male hormones), a large number of immature ovarian follicles (which can be detected after a pelvic ultrasound scan or a hormone blood test), and periods that are either abnormal, irregular, or absent. These hallmarks of the condition can lead to PCOS symptoms, including facial hair growth, acne, and difficulty becoming pregnant.
Finding the right birth-control method is especially important for people with PCOS since it can help manage symptoms — but deciding which birth-control method is the best option is the hard part.
“When picking a birth-control method, it is important to pay attention to one’s PCOS symptoms because birth-control methods may improve some symptoms and could exacerbate other symptoms,” Beth Rackow, MD, assistant professor of obstetrics and gynecology at Columbia University Medical Center and medical advisor at Allara, tells POPSUGAR.
Ultimately, there isn’t a “best” choice when it comes to birth control for people with PCOS, because recommendations should be based on a person’s individual needs. But among the myriad of birth-control options out there, some are better than others. Ahead, experts explain what to consider when choosing the birth-control option best for you.
How Can Birth Control Help with PCOS?
There are two major categories of birth-control methods: hormonal and nonhormonal. Hormonal birth-control methods contain either a combination of estrogen and progestin hormones or progestin only. These methods work by either suppressing ovulation (therefore preventing an egg from being released), thickening cervical mucus to make it more challenging for sperm to reach an egg, or thinning the lining of the uterus to prevent implantation. Hormonal birth-control methods include oral contraceptives (the pill), hormonal intrauterine devices (IUDs), implants, injections, vaginal rings, and skin patches.
Non-hormonal birth-control options include barrier methods (such as condoms), copper IUDs, and vaginal gels, like Phexxi. These methods do not use supplemental hormones to prevent pregnancy.
In addition to helping to prevent pregnancy, birth control methods (particularly those that contain estrogen and progestin) can help regulate menstrual bleeding, and reduce the presence of certain PCOS symptoms, including excessive hair growth and acne, per the Mayo Clinic. Combination hormone methods (think: pills, rings, patches, etc.) can also lower your risk of endometrial cancer.
Which Birth-Control Methods Are Best For PCOS?
Hormonal birth control is typically the first choice for people with PCOS, says Dr. Rackow. Those with PCOS often have hormonal imbalances that result in irregular cycles, making it very difficult to predict when they’re most fertile. For this reason, among others, physicians often prescribe hormonal birth control to help restore some balance and regulate the menstrual cycle.
A combination of estrogen and progestin (a synthetic form of progesterone) is the most commonly prescribed hormonal birth-control method for those with and without PCOS. This type of birth control can be delivered through a pill, patch, or vaginal ring. Progestin-only hormonal birth-control methods include pills, injections, implants, and IUDs, which can also be effective. More on the specifics of both below.
Combined oral contraceptives (COCs), meaning pills that contain both estrogen and progestin, are considered a “first-line medical treatment for the long-term management of PCOS,” according to the Endocrinology and Metabolism Journal. They are “the mainstay for PCOS treatment,” Jennifer Lew, MD, a board-certified ob-gyn at Northwestern Medicine Kishwaukee Hospital, tells POPSUGAR. The estrogen in this birth-control method helps to regulate periods, which can have long-term health implications. Additionally, Dr. Rackow shares that contraceptives that contain estrogen work to lower testosterone, improving symptoms like acne and facial hair.
This form of birth control can be self-inserted into the vagina without the help of a medical professional. Depending on the type of ring you choose (the brand names include NuvaRing or ANNOVERA) it can last anywhere between five weeks to a year before needing to be replaced.
Because it contains the same combination of hormones that is found in oral contraceptives (estrogen and progestin), it also offers many benefits for those with PCOS, like helping with ovulation, period regulation, and improving symptoms like acne and facial hair.
This is a great option for those who do not want to have to remember to take an oral-contraceptive pill daily, but who also want to relieve their PCOS symptoms.
Per Planned Parenthood, the skin patch is a “transdermal contraceptive patch” worn on certain parts of your body — like your stomach, upper arm, back, or butt — that releases the hormones estrogen and progestin through your skin and also prevents pregnancy. Because the skin patch releases hormones, it can ease PCOS symptoms similarly to the way oral contraceptives can.
An implant, sold under the brand names Implanon and Nexplanon, is a birth-control option containing only progesterone — not estrogen. The implant is inserted into a person’s arm and can last and prevent pregnancy for up to three years.
Though an implant only contains progesterone, this is a great option for PCOS patients who can’t take estrogen-containing birth control for medical reasons (such as a history of blood clots), says Dr. lew. However, she cautions that this type of birth control, while an effective choice for preventing pregnancy, does not regulate the menstrual cycle. Because of this, it may not be as effective at helping PCOS symptoms.
An intrauterine device (more commonly known as an IUD) is a T-shaped device that’s medically inserted through the cervix and into the uterus, where it works to prevent pregnancy. There are two types of IUDs: one that contains progestin and can help ease PCOS symptoms, and another called the copper IUD, which doesn’t release hormones and only works to aid pregnancy prevention.
The copper IUD does not help with symptoms of PCOS, since it does not release hormones. However, IUDs containing progestin can alleviate PCOS symptoms in the same way other progestin-only birth-control options can, like the implant and injection.
A contraceptive injection, also known by the brand name Depo-Provera, is another birth-control option that only contains the hormone progestin — not estrogen. Per the Mayo Clinic, the shot can be administered every three months and is used to prevent pregnancy and manage medical conditions related to your menstrual cycle.
Similarly to the implant, Dr. Lew says this form of birth-control option is great for those who don’t want to take a daily pill, want to avoid using estrogen, and would like to alleviate some PCOS symptoms. However, it may not be as effective at helping PCOS symptoms as a birth-control option that does contain estrogen. In fact, For Dr. Lew warns, “people with PCOS who struggle with weight gain should be cautious using injectable progestins because some individuals experience weight gain on this medication.”
Ultimately, only you and your doctor can decide which birth control method is right for you, so make an appointment with your ob-gyn to figure out an option that will best address your lifestyle and needs.
— Additional reporting by Taylor Andrews
Image Source: POPSUGAR Photography / Matthew Kelly